Procedure Logs

C3.1 R4(e): Perform & document an aminoglycoside pharmacokinetic interpretation

HB is a 33+6/7 week baby who presented with risk factors for sepsis (mom had variable decels during delivery, query GBS status – treated with 3 doses of Pen G). HB presented with some temperature instability (37.6C), 2 episodes of apnea, brady and desats (previously had no ABDs).  HB was started on ampicillin + gentamicin for neonatal sepsis empiric coverage, blood cultures were taken and gentamicin levels were taken around the 5th dose. The plan was to continue the gentamicin for 5 days based on the clinical signs and symptoms and risk factors. Gentamicin dose is 6.7mg IV Q18H (=2.5mg/kg/dose) which is appropriate empirically based on the FH neonatal PDTM dosing guidelines for gentamicin (based on GA and day of life).

  • Levels were taken on Oct 2, pre (taken 30 minutes late) = 0.9 mg/L [aim for <2]
  • Oct 2, post (taken appropriately) = 7.3 mg/L [aim for 5-10mg/L]

HB gent math

Based on this I wrote the following note in the chart:

Clinical Pharmacist Note re: gentamicin levels:

Patient is receiving gentamicin 6.7mg IV Q18H since Sept 29 0030. Levels taken on Oct 2 around the 5th dose (dose given at 0700):

  • 0700: 0.9 mg/L [range <2 mg/L], extrapolated min = 0.9mg/L
  • 0800: 7.3 mg/L [range 5-10mg/L], extrapolated max = 7.8mg/L
  • Patient t1/2 = 5.6 h [aim for 3-11.5h]
  • Vd = 0.34 L/kg [aim for 0.35-0.55 L/kg]
  • Creatinine = 36 umol/L, Urine output = 3.67 ml/kg/hour

Suggest no change to gentamicin regimen at this time as all pharmacokinetic values are within normal range. No further levels required at this time.

– Iona Berger, Pharmacy Resident

This was a great patient to practice my gentamicin PK skills on, as the levels were taken appropriately in relation to the dose, and there were no strange anomalies in the patient’s specific PK parameters.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s